Siena College poll: Conflicting views about drug users, addiction

Should opioid abusers pay the price for their choices?

Siena College poll: Conflicting views about drug users, addiction

Most New Yorkers agree: The opioid epidemic is worse than public health crises of the past.

But the latest results from a Siena College poll show just how far we'd go to combat it, and reveal what some say are conflicting ideas about personal choice and responsibility when it comes to people who use drugs.

Consider this view: Nearly four out of five New Yorkers agree that addiction to opioids is a disease and ought to be treated like one, in the same way we would treat someone with cancer or heart failure.

And yet, New Yorkers are split when asked whether someone who abuses opioids should pay the price for their choices. Forty-nine percent say it's "not up to the rest of us" to fix their problems.

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Those are contradictory beliefs if you play them out logically, addiction experts say. A person's early decision to use opioids may have been a choice, they say. But the repeated use of such substances can alter a person's brain chemistry so that the "choice" becomes hard-wired. Once addicted, stopping the drug can cause aches, sweats, vomiting, diarrhea, depression and extreme agitation, which further reinforce the brain's new wiring.

"There is still a lot of stigma out there and misinformation," said Dr. Melissa Weimer, medical director of St. Peter's Health Partners Addiction Recovery Center. "But I am happy to see shifts in how people are seeing addiction as a disease rather than a moral failing."

This matters because what we believe about drug use and dependence often informs how we respond in the moment someone seeks help.

In the final installment of Siena's first-of-a-kind survey on opioids, nearly 1,400 New Yorkers revealed initiatives they would support as public health experts predict the death toll from opioids could hit half a million Americans in the next decade.

Nine out of 10 New Yorkers say they support strengthening prescription monitoring programs that prevent addicts from "doctor shopping" for multiple prescriptions. The widespread availability of prescription painkillers like Vicodin and Oxycodone are believed to have fueled the early stages of the epidemic, which explains why four out of five New Yorkers say doctors who overprescribe these medicines should be punished.

Survey-takers also feel strongly about the role pharmaceutical companies played in promoting these drugs as safe. Three-quarters say the state Attorney General should begin legal proceedings against these companies, and 72 percent say they should be held legally and financially responsible for the epidemic.

When it comes to treatment, nearly nine in 10 New Yorkers say we should expand drug rehabilitation programs in jails and prisons. Eighty-five percent say naloxone — a drug that reverses the effects of an opioid overdose — should be readily and freely available.

A majority of New Yorkers also support making more room in emergency departments to treat people who come in with an addiction, expanding access to medications like buprenorphine that curb cravings and block withdrawal symptoms and increasing funding for syringe exchange programs.

Three in five also support legalizing recreational marijuana — a strategy some public health officials believe could reduce opioid dependence.

To the surprise of medical professionals and some lawmakers, four out of five New Yorkers say doctors should be allowed to force someone into treatment if they believe their life is at risk.

"We wouldn't lock someone up and force them to receive chemotherapy for cancer," said Assemblywoman Linda Rosenthal. "And if people truly view addiction as a disease — which it is — then involuntary treatment is absolutely the wrong approach. People cannot get well unless and they are prepared to put in the very hard work involved in recovery. Involuntary treatment infantilizes people who struggle with addiction and deprives them of their rights."

Prescription for Progress Part 4: Results from the Siena College Research Institute survey conducted in February 2018 as part of the "Prescription for Progress: United against opioid addiction" initiative.

Prescription for Progress Part 4: Results from the Siena College Research Institute survey conducted in February 2018 as part of the "Prescription for Progress: United against opioid addiction" initiative.

Photo: Tyswan Stewart

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Prescription for Progress Part 4: Results from the Siena College Research Institute survey conducted in February 2018 as part of the "Prescription for Progress: United against opioid addiction" initiative.

Prescription for Progress Part 4: Results from the Siena College Research Institute survey conducted in February 2018 as part of the "Prescription for Progress: United against opioid addiction" initiative.

The Democratic lawmaker, who chairs the Assembly committee on alcoholism and drug abuse, was even less thrilled that just 41 percent of New Yorkers say we should fund the creation of safe consumption spaces, where people addicted to illegal drugs can consume them under medical supervision and without fear of arrest.

"There continues to exist a tremendous stigma around substance use disorder," she said. "The stigma was reinforced for generations as society fought and continues, in some places, to fight a failed war on drugs. Society demonized users and their disease, and denied them treatment, agreeing instead that incarceration was the right approach."

The goal of safe consumption sites is to reduce overdose deaths by taking a pragmatic approach known as harm reduction: Some people will use no matter what you do. So why not keep them safe until they are ready to stop?

Nearly 100 safe consumption sites exist around the world, but they are highly controversial in the U.S., where only a few cities have been able to convince lawmakers to pursue them. The first U.S. site is expected to open later this summer in San Francisco, and this week New York City Mayor Bill de Blasio agreed to support repeated calls for the sites in drug-ravaged communities.

Rosenthal, who introduced a bill last summer to get the spaces in New York, said it's on lawmakers to support policies that are proven to save lives even if they are potentially difficult.

"Even though we have moved to a harm reduction model of care, with medication assisted treatment now the standard of care in this country, it will take some time for public attitudes to change," she said. "The sad reality, however, is the one thing we don't have is time. Harm reduction approaches, such as safer consumption spaces, are evidence-based, proven, effective methods that save lives. The public attitudes are not unfair, but they imperil thousands of people."